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Neurology > Brainstem 2 > Flashcards

Brainstem 2 Flashcards

1
Q

2 nuclear groups related to CN 11 - spinal accessory

A
  • brainstem portion: nucleus ambiguous

- SC portion

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2
Q

what makes CN 11 unique?

A

fibers from the SC nucleus go back up through the foramen magnum before exiting

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3
Q

what CNs are similar in their functional components and therefore share many of the same nuclei?

A
  • CN 10 - Vagus
  • CN 9 - glossopharyngeal
  • CN 7 - Facial
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4
Q

4 nuclei for CN 10 and their modalities

A
  • DMN of 10: preganglionic parasympathetic
  • nucleus ambiguous: somatic motor
  • solitary nucleus: VA and taste
  • SNT of CN 5: somatic sensation
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5
Q

what is the function of the 4 nuclei used by CN 10?

A
  • DMN of 10: visceral motor to thorax and abdomen
  • ambiguous: go to contrictors of larynx and pharynx to aid in swallowing
  • solitary: taste to base of tongue
  • SNT of CN 5: somatic sensory from ear canal
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6
Q

what is a notable relationship of the 4 nuclei of CN 10?

A

if you put ice water in someone’s ear, you will get a vagal response of vomiting and decreased HR

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7
Q

4 nuclei and modalities of CN 9 - glossopharyngeal

A
  • inferior salivatory nucleus: preganglionic parasympathetics
  • nucleus ambiguous: somatic motor
  • solitary nucleus: taste and VA
  • SNT of CN 5: somatic sensation
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8
Q

what is the function of the 4 nuclei used by CN 9?

A
  • inf. salivatory: autonomic innervation of parotid
  • ambiguous: inn. larynx and pharynx w/ CN 10
  • solitary: taste to posterior 1/3 of tongue
  • SNT of CN 5: somatic sense form outer ear
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9
Q

what is an important distinction of how innervation occurs from the brainstem?

A
  • brainstem nuclei are driven by higher centers

- w/ rare exception, everything is innervated b/l

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10
Q

what are the exceptions of b/l innervation?

A
  • lower half of the facial nucleus

- accessory nucleus (he didn’t spend time on this one)

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11
Q

CN 8 - vestibulocochlear tracts and nuclei

A
  • bipolar neurons from vestibular apparatus have ganglion out in temporal bone and send process to the 4 vestibular nuclei
  • the lateral one becomes the vestibulospinal tract
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12
Q

what is another pathway that is connected with the vestibulochochlear?

A

MLF - median longitudinal fasciculus

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13
Q

MLF

A

-connect vestibular nuclei of CNs 6, 4, and 3 to the vestibular apparatus to control EOMs

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14
Q

lesion of the MLF =

A

dolls eyes

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15
Q

dorsal column / medial lemniscal pathway modalities:

A
  • fine touch
  • vibration
  • pressure
  • 2 pt discrimination
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16
Q

how can you easily ID the dorsal column pathway?

A

everything is on the same side until reaching the nucleus gracilis and cuneatus where the decussation occurs

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17
Q

lesion below the dorsal column decussation:

A

ipsilateral sensory loss

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18
Q

lesion above the dorsal column decussation

A

contralateral sensory loss

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19
Q

how is the dorsal column pathway arranged?

A

somatotopically

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20
Q

spinothalamic tract modalities

A
  • pain

- temp

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21
Q

path of the spinothalamic tract

A
  • enter at lamina 2 (sunstantia gelatinosa) and cross the anterior white commissure
  • enter spinothalamic tract and ascend to VPL of thalamus
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22
Q

corticospinal tract

A
  • voluntary motor
  • originates at pre central gyrus and descends in cerebral peduncles, crosses in pyramidal decussation and continues down as pyramids
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23
Q

anatomically significant structure you would find in a cross section of the inferior pons:

A
  • medial lemniscus
  • descending spinal tract of nucleus of CN 5
  • nucleus of CN 7
  • 4th ventricle
  • facial colliculus
  • superior olivary nucleus
  • group of scattered nuclei at ventral surface
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24
Q

what are the 3 types of descending fibers from the pre central gyrus?

A
  • corticospinal
  • corticopontine (seen in cross section)
  • corticobulbar (ones that end in nuclei of brainstem like hypoglossal)
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25
Q

4 nuclei and their modality of CN 7 - Facial

A
  • nucleus of CN 7 - motor
  • superior salivatory: preganglionic parasympathetic
  • solitary nucleus: taste, VA
  • SNT of CN 5: somatic sensation
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26
Q

what is the function of the 4 nuclei used by CN 7?

A
  • nucleus of CN 7: motor to muscles of facial expression
  • superior salivatory: PSNS inn. of submandibular, sublingual and lacrimal glands
  • solitary: taste to anterior 2/3 of tongue
  • SNT of CN 5: somatic sensation of face
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27
Q

what is unique of the formation of CN 7 nuclei and related structures?

A
  • the axons exit the nucleus medially and go up and around nucleus of CN 6
  • this forms the facial colliculus in the floor of 4th ventricle
28
Q

Bells Palsy

A

-lesion of facial motor nucleus or entire facial n.

29
Q

a bells palsy lesions causes:

A

entire ipsilateral face cannot move - can’t raise eyebrows

30
Q

a stroke lesion:

A
  • will knock out lower face on contralateral side, but n. going to frontalis is b/l innervated
  • CAN raise eyebrows
31
Q

pop quiz:

if you have a lesion at midline of the low medulla, what will it effect?

A

tongue

32
Q

CN 6 - abducens

A

reminder: LR6 SO4
- comes out of its nucleus to go inn. lateral rectus muscle
- b/l innervation
- exits brainstem at pontomedullary jxn

33
Q

3 sensory parts of the trigeminal nucleus

A
  1. mesencephalic
  2. pontine / principal / main area
  3. spinal portion

*pons also holds the motor component of CN 5

34
Q

mesencephalic nucleus of CN 5 is responsible for:

A

proprioception of face and jaw / oral cavity

35
Q

pontine / principal area of CN 5 is responsible for:

A

touch

36
Q

spinal part of CN 5 is responsible for:

A

pain and temp of skin of face

37
Q

how to think of the different CN 5 nuclei areas:

A
  • clinical applications
  • a lesion in the medullary portion (SC portion) probably wouldn’t effect how the face percieves touch but it would effect temp
38
Q

what is unique about the trigeminal ganglion?

A

goes to the VPM not VPL of the thalamus

39
Q

another unique aspect of trigeminal ganglion

A

-1st order neuron for porprioception is not in the trigeminal ganglion
-it’s in the mesencephalon
=displaced ganglion

40
Q

because innervation is so bilateral, when are the only 2 occasions that you lose sensation of the face?

A
  1. brainstem lesion

2. trigeminal lesion that effects the n. itself

41
Q

once synapsed in the main and spinal nucleus of CN 5, efferents project collateral to where? (other than the VPM)

A
  • facial motor nucleus
  • superior salivatory nucleus
  • inferior salivatory nucleus
  • CN 12
  • vagal parasympathetics
42
Q

CN V role at the facial motor nucleus

A

-the opthalmic division (V1) of CN 5 goes to facial motor nucleues and bilaterally innervates the cornea

43
Q

effects on blink reflex if V1 (opthalmic division of CN 5) is cut:

A
  • touch cornea of effected side = nothing

- touch cornea of contralateral side = both eyes blink

44
Q

effects on blink reflex in Bells Palsy:

A
  • touch same side cornea: will feel pain (b/c nothing wrong w/ V1) but can’t blink (CN 7)
  • touch contralateral side: will blink
45
Q

CN V role at the superior salivatory nucleus

A
  • aka lacrimal nucleus

- produce tears following corneal sensation by stimulating CN 7

46
Q

CN V role at the superior AND inferior salivatory nucleus

A

salivation

47
Q

CN V role at the CN 12

A
  • coordinate tongue movements

- i.e: keep tongue out of the way while chewing

48
Q

CN V role at Vagal parasympethics:

A
  • pressure in mouth

- ex: vomiting from biting a piece of cartilage

49
Q

structures of the mesencephalon

A
  • ventral: cerebral peduncles
  • dorsal: CNs 3 and 4 and colliculi
  • cerebral aqueduct runs through it
50
Q

CN 4 - trochlear

A
  • midline so motor

- goes to inn. superior oblique (LR6 SO4)

51
Q

2 unique things about CN 4

A
  • exits the brainstem dorsally

- crosses before it exits

52
Q

a lesion to CN 4 outcome:

A

lesion is contralateral to affected side

53
Q

CN 3 - occulomotor

A
  • in mesencephalon
  • exits medially
  • innervates all EOM muscles other than LR and SO
54
Q

2 nuclei of CN 3

A
  • CN 3 nucleus: somatic efferents

- edinger-westphal nucleus: pregangionic parasympathics

55
Q

function of CN 3 at the edinger westphal nucleus:

A

contrict pupils

56
Q

convergence and accomodation is performed by:

A

CN 3

57
Q

argyll-robertson pupil

A
  • nuerosyphilis abolishes light reflex w/o affecting accomodation
  • “prostitutes pupil”
  • think tabes dorsalis
58
Q

substantia nigra

A

part of the extrapyramidal system so modulates the pyramidal system

59
Q

2 parts of the substantia nigra:

A
  • receptive part: receives info from caudate

- projection part: dopamine and Ach neurons

60
Q

dopamine

A

inhibitory

61
Q

ach

A

excitatory

62
Q

lesion in the pyramidal system:

A

paralysis

63
Q

lesion in extrapyramidal system:

A

not paralysis but motor activity will not be normal (throwing paper towels up to ceiling insted of picking it up example)

64
Q

what is an example of a substantia nigra / extrapyramidal lesion that manifests in a disease?

A

Parkinson’s tremor

65
Q

inferior colliculus

A

relay nucleus related to hearing

66
Q

superior colliculus

A
  • vision
  • origin of tectospinal tract
  • it doesn’t “see” it interprets

Neurology (11 decks)

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